Undocumented workers deserve health care

As if in a perfect storm, the politics of health and immigration reform have suddenly and unexpectedly clashed, creating a contentious atmosphere to debate the arguments for and against certain health reform initiatives. Within this context, as a public health advocate for underserved and vulnerable people, I believe that, as a society, we have an ethical and social responsibility to provide health care coverage to the undocumented immigrant community.

The relevance of “social responsibility” relates to what I consider to be the major policy deficiency of President Barack Obama’s signature legislation dealing with health reform – the Affordable Care Act of 2010 (ACA) – which denies insurance coverage to undocumented immigrants. Specifically, the ACA prohibits undocumented immigrants from receiving Medicaid or SCHIP services.

In addition, because the ACA fails to recognize undocumented immigrants as “qualified individuals,” they are not allowed to purchase health insurance through state-operated health exchanges, even if they have the money to purchase such coverage.

Assuredly, the debate over immigration reform will generate considerable opposition to practical reforms, just as in the area of comprehensive health reform, due to a litany of policy misrepresentations foisted on the public by political opponents.

Essentially, three positions represent the principal “opposing” arguments against extending health care coverage to undocumented immigrants: 1) Our existing health care delivery system is already overburdened by treating undocumented immigrants, and we risk its viability by expanding services so significantly; 2) Taxpayers cannot afford to pay for extending health care coverage to undocumented immigrants; and 3) Undocumented immigrants come to the United States primarily to gain access to free health services.

The facts for each of these assertions tell a different story.

Argument No. 1: “Our care system is overburdened.” It’s important to recognize that undocumented immigrants do not overburden our health care system because they are not eligible for Medicaid or State-Children’s Health Improvement Program (SCHIP). A 2006 study by the Rand Corp. reported that “of the $430 billion in national medical expenditures in 2000, native-born residents accounted for 87 percent of the population, but for 91.5 percent of the spending. Undocumented immigrants (3.2 percent of the population) accounted for only 1.5 percent of medical costs.”

Argument No. 2: “We simply can’t afford it.” Health economists generally address the “affordability” question by pointing out the fact that costs associated with extending coverage to undocumented immigrants are more than offset by systemwide savings in two key areas: (1) the decreased use of emergency medical services (and increased use of preventive and primary care services); and (2) reduced insurance premiums for all insured individuals by enrolling a population of individuals that is generally healthier than the legal immigrants and citizens who already compromise the program’s risk pool.

Argument No. 3: “Immigrants are seeking free services.” Those who work with the immigrant community understand that immigrants do not come to the United States for health care, but are attracted by the “magnet” of job opportunities and higher wages in such industries as agriculture, construction, food processing, landscaping and hotel services.